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25-06-2020 | Rheumatology | News | Article

Age, comorbidities linked to poor COVID-19 outcomes in patients with rheumatic diseases

Author:
Claire Barnard

medwireNews: Rheumatic diseases and their treatments may not be associated with outcomes of SARS-CoV-2 infection, but older age and comorbidities are likely risk factors for a severe COVID-19 disease course in rheumatology patients, suggest findings from two studies.

In the first study, published in The Lancet Rheumatology, Italian researchers analyzed the incidence of COVID-19 in 1525 patients from their rheumatology clinic. A total of 117 (8%) had symptoms compatible with COVID-19; of these, 65 tested positive for SARS-CoV-2 infection, while 52 had COVID-19 symptoms but were not tested.

“Patients who were not tested for SARS-CoV-2 infection were treated at home by their general practitioners because they presented with milder symptoms of COVID-19,” note Micaela Fredi (University of Brescia) and colleagues.

On the other hand, they report that 72% of patients with confirmed SARS-CoV-2 infection developed pneumonia that required hospital admission. A total of 12 (10%) patients with confirmed and two (4%) of those with suspected COVID-19 died.

There were no significant differences in the distribution of rheumatic diseases nor the type of treatment used among patients with confirmed versus suspected COVID-19, but those with confirmed infection were significantly older on average (68 vs 57 years) and were more likely to have arterial hypertension (51 vs 27%) or obesity (17 vs 2%).

In addition, the researchers assessed the outcomes of 26 hospitalized COVID-19 patients with a rheumatic disease compared with 62 COVID-19 patients from the same hospital who did not have a concomitant rheumatic disease. There were no significant differences in disease course – including duration of COVID-19 symptoms before admission, length of hospital stay, and interstitial pneumonia severity as measured by X-ray Brixia score – nor in levels of inflammatory biomarker levels among the two groups. People with rheumatic diseases experienced a significantly greater degree of lymphopenia than those without, however.

“Based on the current findings, pre-existing systemic autoimmune disease and ongoing immunosuppressive treatment do not appear to represent the most important risk factors for SARS-CoV-2 infection and for its final outcome,” write Fredi and team.

“Instead, mortality seems to be associated more with older age and the presence of comorbidities rather than the degree of pharmacological immunosuppression.”

In the second study, Chinese researchers report the outcomes of 2804 inpatients with COVID-19, of whom 17 (0.61%) had concomitant rheumatic diseases.

Shenghao Tu (Tongji Hospital, Wuhan) and colleagues write in the Annals of the Rheumatic Diseases that the number of patients with rheumatic diseases in their study “was far below our expectations,” given that such conditions “might affect approximately 3%–10% of the total population.”

The majority of these patients were given antiviral therapy (94.1%) and antibiotics (88.2%) and oxygen support (76.5%); one individual with systemic lupus erythematosus and other chronic conditions and severe pneumonia at the time of admission died, while the remaining 16 patients were discharged after a median 28.0 days in hospital.

Tu and team note that 10 (62.5%) patients changed or stopped their rheumatic disease treatment during hospitalization for COVID-19, and half of these people felt that their disease had worsened as a result, suggesting that “the withdrawal of anti-[rheumatic] treatments during hospitalisation can lead to flares of diseases.”

In another part of their study, the researchers assessed risk factors for poor outcomes in 1255 patients with COVID-19 from their hospital, 20 of whom had autoimmune diseases. They found that older age and the presence of various comorbidities – including diabetes, coronary heart disease, and cerebrovascular disease – were significant predictors of admission to the intensive care unit (ICU), but there was no association between autoimmune disease diagnosis and ICU admission.

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature Group

25 June 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Lancet Rheumatol 2020; doi:10.1016/S2665-9913(20)30169-7
Ann Rheum Dis 2020; doi:10.1136/annrheumdis-2020-217425

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